RAPID score in Covid-19 patients: a clinical-radiological index for the safe discharge from the Emergency Department. A preliminary report


https://doi.org/10.4081/ecj.2020.9192
Vol. 16 No. 3 (2020)
Submitted: 17 June 2020
Accepted: 7 November 2020
Published: 23 December 2020
Covid-19, triage, score, RAPID-Covid score, Chest X-Ray
Abstract Views: 867
PDF: 340
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Authors

  • Filippo Vaccher
    f.vaccher@unibs.it
    Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Ciro Paolillo Emergency Department, ASST Spedali Civili di Brescia, Brescia, Italy.
  • Nunzia Di Meo Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Marco Ramanzin Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Marco Ravanelli Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Roberto Maroldi Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.
  • Davide Farina Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia; Radiologia 2, ASST Spedali Civili di Brescia, Italy.

To evaluate the performance of a clinical-radiological index (RAPID-Covid score) in achieving Safe Discharge (SD) of patients accessing the Emergency Department (ED) with symptoms suggesting Covid-19. Clinical and radiological data were retrospectively collected from 853 consecutive patients admitted to the ED during the pandemics with symptoms suggesting Covid-19. Illness severity was graded with RAPID-Covid score, composed of chest X-ray findings, clinical symptoms and PaO2/FiO2. Patients with RAPIDCovid score ≥5 were admitted. Primary outcome was SD of patients to home care. SD was defined as survival of the patient, without evidence of second access to ED requiring hospitalization. 212/853 patients were discharged. 27/212 had a score ≥5 but refused admission. 185/212 were discharged with score <5: 147/185 (79,5%) survived and did not re-access ED; 1/185 (0,5%) died at home after first ED-dismissal; 37/185 (20,0%) had a second access. Of these 15/37 (8,1%) were newly dismissed and one of them (1/15) died at home; 22/37 (11,9%) were hospitalized, 1/22 died during hospitalization. SD was obtained in 161/185 patients (87%). Readmissions occurred 5,1±2,6days from first discharge. Follow-up was 16,7±6,0days. RAPID-Covid score proves useful for SD of Covid-19 to home care. 6-10days may further increase confidence.


Coronavirus disease 2019 (COVID-19): Outpatient evaluation and management in adults - UpToDate. Accessed September 11, 2020. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-outpatient-evaluation-and-management-in-adults

Clinical management of severe acute respiratory infection when COVID-19 is suspected. Accessed May 4, 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected

Coronavirus disease 2019 (COVID-19): Management in hospitalized adults - UpToDate. Accessed September 11, 2020. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults

Li Y, Xia L. Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. Am J Roentgenol. 2020;214(6):1280-1286. doi:10.2214/AJR.20.22954 DOI: https://doi.org/10.2214/AJR.20.22954

Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-3309. doi:10.1007/s00330-020-06731-x DOI: https://doi.org/10.1007/s00330-020-06731-x

Zhu Y, Gao Z-H, Liu Y-L, et al. Clinical and CT imaging features of 2019 novel coronavirus disease (COVID-19). J Infect. 2020;81(1):147-178. doi:10.1016/j.jinf.2020.03.033 DOI: https://doi.org/10.1016/j.jinf.2020.03.033

Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. Published online February 26, 2020:200642. doi:10.1148/radiol.2020200642 DOI: https://doi.org/10.1148/radiol.2020200642

Borghesi A, Maroldi R. COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression. Radiol Med (Torino). Published online May 1, 2020. doi:10.1007/s11547-020-01200-3 DOI: https://doi.org/10.1007/s11547-020-01200-3

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239. doi:10.1001/jama.2020.2648 DOI: https://doi.org/10.1001/jama.2020.2648

Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. doi:10.1001/jama.2020.1585 DOI: https://doi.org/10.1001/jama.2020.1585

Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention - UpToDate. Accessed September 11, 2020. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention

Liu Y, Yan L-M, Wan L, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656-657. doi:10.1016/S1473-3099(20)30232-2 DOI: https://doi.org/10.1016/S1473-3099(20)30232-2

Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5 DOI: https://doi.org/10.1016/S2213-2600(20)30079-5

Liang W, Liang H, Ou L, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180(8):1081. doi:10.1001/jamainternmed.2020.2033 DOI: https://doi.org/10.1001/jamainternmed.2020.2033

Chen Z-M, Fu J-F, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. Published online February 5, 2020. doi:10.1007/s12519-020-00345-5 DOI: https://doi.org/10.1007/s12519-020-00345-5

Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls. StatPearls Publishing; 2020. Accessed May 4, 2020. http://www.ncbi.nlm.nih.gov/books/NBK554776/

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5 DOI: https://doi.org/10.1016/S0140-6736(20)30183-5

Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934. doi:10.1001/jamainternmed.2020.0994 DOI: https://doi.org/10.1001/jamainternmed.2020.0994

Aziz MF. The COVID-19 intubation experience in Wuhan. Br J Anaesth. 2020;125(1):e25-e27. doi:10.1016/j.bja.2020.04.058 DOI: https://doi.org/10.1016/j.bja.2020.04.058

Yang M, Dong H, Lu Z. Role of anaesthesiologists during the COVID-19 outbreak in China. Br J Anaesth. 2020;124(6):666-669. doi:10.1016/j.bja.2020.03.022 DOI: https://doi.org/10.1016/j.bja.2020.03.022

Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA. 2012;307(23). doi:10.1001/jama.2012.5669 DOI: https://doi.org/10.1001/jama.2012.5669

Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016;315(8):788. doi:10.1001/jama.2016.0291 DOI: https://doi.org/10.1001/jama.2016.0291

Chen J, Qi T, Liu L, et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect. 2020;80(5):e1-e6. doi:10.1016/j.jinf.2020.03.004 DOI: https://doi.org/10.1016/j.jinf.2020.03.004

Wong HYF, Lam HYS, Fong AH-T, et al. Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. Radiology. Published online March 27, 2019:201160. doi:10.1148/radiol.2020201160 DOI: https://doi.org/10.1148/radiol.2020201160

Fang Y, Zhang H, Xie J, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296(2):E115-E117. doi:10.1148/radiol.2020200432 DOI: https://doi.org/10.1148/radiol.2020200432

the Fenice Network (Italian Group for Clinical Research in Emergency Medicine), Sorlini C, Femia M, et al. The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak. Intern Emerg Med. Published online October 22, 2020. doi:10.1007/s11739-020-02524-8 DOI: https://doi.org/10.1007/s11739-020-02524-8

Vaccher, F., Paolillo, C., Di Meo, N., Ramanzin, M., Ravanelli, M., Maroldi, R., & Farina, D. (2020). RAPID score in Covid-19 patients: a clinical-radiological index for the safe discharge from the Emergency Department. A preliminary report. Emergency Care Journal, 16(3). https://doi.org/10.4081/ecj.2020.9192

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